Statcast Number 16 Transcript

Amy Bernstein, a health statistician with the CDC’s National Center for Health Statistics, discusses the latest annual report on the Nation’s health, “Health, United States, 2009.”

Announcer: Amy Bernstein is the lead author of Health, United States, widely recognized as the federal government’s annual report card on the Nation’s health. This year’s edition of Health U.S. has a special feature on medical technology. Amy, what can you tell us about the effect that medical technology is having on our medical care system?

Bernstein: I think most people would agree that medical technology in all its various forms has improved both the quantity and quality of many, many peoples’ lives. I think it would be hard to think about going to the doctor or the hospital without all of the numerous technologies that are involved with those encounters. I think most people could not conceive of going to the doctor without laboratory tests or vaccinations or X-rays or PET scans or CAT scans and would think that hospitals and doctors that didn’t have access to those things would be pretty much in the dark ages. And as time marches on, we have more and more of these things that actually can diagnose and treat numerous conditions that we were unable to treat in the past.

Announcer: Now, when you are referencing medical technology in this report, what exactly does that include?

Bernstein: We’re defining medical technology in this report as new and existing types of tests, imaging – like PET scans and CAT scans – as well as your normal X-rays, and any kind of procedure, devices, and machinery that can be used to diagnose and treat conditions.

Announcer: What are some areas in medical technology that have seen some of the largest growth?

Bernstein: Our special feature is just a snapshot of selected things, so I can’t talk to the full the range of medical technologies, but some of the things that we focused on were what we call advanced imaging procedures such as MRI, CT, or PET scans. Between 1996 and 2007, there was more than a threefold increase in the number of visits per population to physicians’ offices that had these advanced imaging technologies provided, and there was a fourfold increase in these advanced imaging technologies ordered or provided during emergency department visits. So we’re seeing a very rapid growth in visits that have these advanced imaging technology ordered or provided during the visits.

Announcer: Is the use of medical technology driving costs up unnecessarily?

Bernstein: Unfortunately, we don’t have a lot of good data on costs, and we focused more on utilization of different kinds of technologies. We do have one chart that looks at hospital procedures that contribute the most to hospital costs, and the one that topped the list was respiratory intubation.

Announcer: Then would you say we might be seeing an overuse of this medical technology?

Bernstein: Again, that’s not really something that the report addresses. We document trends and use of different kinds of technologies, but it’s very hard to say anything about appropriate or inappropriate use. That requires a much more in-depth study by clinicians.

Announcer: Did you determine in this report whether the use of medical technology is fairly even across different race and gender groups, or did you notice any disparities?

Bernstein: For some technologies, there seems to be pretty equitable use. For other ones, it is fairly clear that there are still some disparities. Again, we don’t know whether there is overuse in some populations or under use in others, but for example, in use of mammography for detection of early breast cancer, there are differences by race and ethnicity where African American and white women are more likely to have had a mammogram in the last two years than Hispanic origin or Asian origin women. That is just one example, but there are others throughout the book. Another example is that women with high cholesterol are much less likely to be receiving a statin drug than men with high cholesterol.

Announcer: Are there any other findings in this report that might be surprising?

Bernstein: One of our new charts this year that I thought was a little bit interesting was a chart on people who have trouble sleeping, and it turns out that among adults, about 30% of them report that they almost always or often had trouble sleeping in the past month.

Announcer: Anything else you’d like to add?

Bernstein: I’d just like to emphasize that the report is a very, very comprehensive report with lots and lots of numbers in it, and if you want your latest life expectancy numbers or infant mortality numbers or utilization of healthcare numbers, this is one place where you can find all those numbers together. And I also want to mention that this year we are putting out a new little summary report called “In-Brief,” which has some of the what we consider key statistics in a very short document if you don’t want to go through the whole 560 pages of the big book.

Announcer: Our thanks to Amy Bernstein for joining us on this edition of “Statcast.” “Statcast” is a production of the Public Affairs Office at the National Center for Health Statistics.